Strengths and Limitations of the Study

Strengths and Limitations of the study 

The strength of this study lies in the diversity of selected populations in key journals, from studies conducted in the last 10 years, which provided up to date information. Selection of different countries enabled the provision of context for comparison with studies done in the UK, and hence enhances the scope for generalizability. Older studies and literature reviews were also used to support or contest key points highlighted by the selected journals. The strength was also attributed to the diversity in the population studied in these journals, which helps to corroborate and compare results, as well as to identify any variants in the studies. Each journal has been analysed separately, and their results have been compared thematically to align their findings under common groups. This helped to identify the strengths of the studies as well as understand the support provided by other studies to the highlighted findings.

However, a major constraint was the lack of time to conduct a more thorough research, and the inability to include more studies in the key journals for an even wider and robust understanding of the issues as only 5 journals were selected and reviewed. This was a weakness, because it prevented a larger literature to be analysed and therefore potentially limit the scope of this study. Additionally, journals published more than 10 years were not selected for the critical analysis. Therefore, any pertinent aspects highlighted by those studies which were not addressed in newer studies were omitted from the discussion, and thus could be a significant source of weakness of the study.

Since this study was conducted in a short span of time, it also limited the scope of research that analysed each factor to its depths and analyse each contributing factors thoroughly. Instead, factors highlighted by the selected few journals were discussed, and also any studies that supports the findings were also discussed briefly, instead of analysing the merits and demerits of each of the supportive findings in a similar structure. This was also a significant weakness for the study. However, maximum effort has been focussed on developing a balanced view on the issue of domestic abuse through the analysis of credible and relevant literature.

What are the effects of domestic violence on children’s mental health

According to Domestic Violence Roundtable, children in the age group of 3-17 years are at the most risk of the adverse effects of domestic violence, and 95% of the incidents are directed towards the women, as victims to their male partners, with the children often being the witnesses of these acts (domesticviolenceroundtable.org 2018). Effects of domestic violence on children includes: poor concentration, hyperactivity, aggression, disobedience, sleeping disturbances, social withdrawal, and lack of emotion, pessimism, and physical symptoms (Domesticviolence.com.au 2018; Van der Kolk 2017; Tsavoussis et al. 2014; Herman 2015; Cook et al. 2017). Children exposed to domestic violence can develop learning difficulties, have reduced social skills, violent and delinquent behaviour and can also suffer from anxiety and depression (Cook et al. 2017; Thabet et al. 2015). The vulnerability is particularly high in case of young children than older ones. Additionally, such children are at a higher risk of being victims of abuse themselves, also the likelihood of the children perpetuating the cycle of violence themselves to their next generations is very high apart from the overall harm to their own wellbeing (unicef.org 2018; Cater & Øverlien, 2014; Milaniak & Widom, 2015; Costa et al. 2015; Foshee et al. 2016; Iratzoqui et al. 2018; Völkl-Kernstock et al. 2016)

Question Context

Almost 140-145 countries have laws against domestic violence and sexual abuse (unwomen.org 2018). However, the existence of laws against it does not always mean compliance with international recommendations or standards. In 37 countries rape perpetrators are exempted from prosecution if they are married to the victim, or subsequently marry the victim after the incident (unwomen.org 2018).

In the UK, no specific criminal offence exists for domestic violence; instead the offenders can be implicated by a number of different offences due to an act of domestic violence (Strickland and Allen 2017). The criminal offence can range from rape, murder, manslaughter as well as assault and threatening behaviour. For coercive and controlling behaviour in an intimate or family relationship, an offender can be penalised under section 76 of Serious Crime Act 2015 (legislation.gov.uk 2018). Civil laws like Family Law Act 1996 and Domestic Violence Crime and Victims Act 2004 safeguards the victims from their abuser through occupation orders (to exclude the abusers from home) and non-molestation orders (preventing molestation of the victims). Further protection is also provided by the Harassment Act 1997 that includes non-harassment and restraining orders (Strickland and Allen 2017; legislation.gov.uk 2018).

According to the World Health Organization, the interplay between different factors that can lead to interpersonal violence can be explained through the ‘ecological framework (who.int 2018). This model has been previously used to explain child abuse, youth violence, intimate partner violence (IPV), cyber bullying and abuse of elderly (Merrin et al. 2018; Akhter and Wilson 2016; Dishion 2014; Cross et al. 2015; Melchiorre et al. 2016; Labrum and Solomon 2015; Sitnick et al. 2017). The model comprises of four nested circles, with the innermost circle representing individual and biological history that affects the relationship, the context of the violence forms the second circle, the formal or informal social structures in which the relationship is embedded (like workplace, neighbourhood, social networks, friends circle and peer groups) represents the third circle, and social and economic environment is represented by the outermost circle (who.int 2018).  This shows the different levels at which domestic violence can have adverse effects on individuals.

UK provides help and support to the victims of domestic violence through various policies and support framework like Young People’s Panel (set by NSPCC) – the service aims to include young individuals to partake in decisions about their own wellbeing (nspcc.org.uk 2018; Murray and Hallett 2000; Matthews and Limb 1998; Johnston et al. 2016)

Legal Background

Coercive and controlling behaviour offence (implemented on December 2015)- this service provides protection against coercive and controlling behaviours in domestic environments, domestic violence disclosure scheme (implemented March 2014 that includes right to ask and right to know)- which gives right to the children to disclose any event of domestic violence to authorities, domestic violence protection orders DVPO (implemented 2014)- that provides protection to victims of domestic violence, male victims of domestic and sexual violence fund- providing funding for the treatment and support for victims of domestic and sexual violence, domestic homicide reviews- This allows the authorities to monitor homicide cases related to domestic violence, independent domestic violence advisors IDVA- who are responsible for providing advice to victims  and multi agency risk assessment conference MARAC- which focuses on the different factors and risks of domestic violence and conduct frequent assessments of risk, Adolescent to Parent Violence and Abuse APVA. Also, the provision of indefinite leave to remain (in UK permanently) for victims of domestic violence provides them protection from domestic violence when their countries are not able to do so. Each of these policies has been outlined by the UK Government website (gov.uk 2018).

This is a secondary research done on primary studies of quantitative and qualitative data. The study is made of 5 selected journals (key journals) that are peer-reviewed, and selected from different countries.

Steps taken to identify key research

Search was done using UTS Library Database and NCBI Database, and also Google Scholar search engine for relevant studies.

The selection of key journals is based on papers that conducted primary research as a part of their work such as studies on primary data collected through interviews, self-reporting questionnaires and papers where various tests and scales were selected to find merits and demerits of the study, and its applicability to the future research and formulation of policies.

Terminologies used 

Key terms used for the search are: domestic violence + mental health + children, domestic violence + children, domestic violence + mental health, domestic violence + effects, interpersonal violence + mental health + children, violence + PTSD + children, domestic violence + homicide, domestic violence + language disorder. The keywords were selected to create maximum possible combinations for the search to locate studies that discuss the adverse effects of DV or IPV.

Inclusion and exclusion criteria 

The inclusion criteria for the key journals were based on the following aspects: research type: only the primary researches were selected, the relevance of the study done in the last decade was also put into consideration. Studies done before 2010 were not selected for the key journals, but were used to support/challenge views identified by the selected journals. Secondary research was excluded from key journals, but used to support/challenge the views of the key journals and to gain a review or context perspectives of the research questions. Journals that discussed the causes of DV or IPV, and effects on others (apart from children) were mostly limited to important studies, and not given much focus.

Theoretical Background

Modification of search and rationale 

The search was modified to include studies done globally, in order to gain a wider perspective on the research question. Additionally, keeping in mind the generalizability of the neurobiology and neuropsychology of childhood and the adverse effect of stressful environment on them, studies from different countries were selected for the analysis. The term domestic violence was also interchanged with interpersonal violence since both can have similar adverse effects on the child. Studies that discussed the causes of DV or IPV were also selected for providing context to certain arguments or facts. This was necessary to establish a bidirectional relationship between domestic violence and mental health or behavioural problems.

Boolean operator used in the search was AND, in order to select studies that includes both the keywords. The final search criteria was based on primary studies that analysed the effect of domestic violence on the mental health of children.

Terms used	Article found
domestic violence mental health children	1230000
domestic violence + children	1630000
domestic violence + mental health	1230000
domestic violence + effects	1660000
interpersonal violence + mental health + children	479000
violence + PTSD + children	137000
domestic violence + homicide	134000
domestic violence + language disorder	406000
domestic violence + trauma	424000
domestic violence + psychological health + children	1200000
domestic violence + psychological health	1230000
domestic violence + behaviour	809000
domestic violence + cause	1790000
domestic violence + help seeking	920000
domestic violence + intervention	1330000
violence + children	2510000
domestic violence + poverty	957000
domestic violence + effect on education	1790000
domestic violence + delinquent behaviour	36800

Selection of the number of journals was arbitrarily restricted to 5.

First search was done on UTS library using keywords “language disorders in victims of domestic violence” which showed 52,472 results. The first article by Cobos-Cali was selected.

Second search was done on the UTS library with the keywords “violence exposure and child” that showed 284,845 results. The first article by Mohammad et al. (2015) was selected.

Third search was done on UTS library, with the keywords “intimate partner violence during childhood” which showed 81,515 results. Among the top 5 search results, the first 3 were discarded, since they were not primary studies, and the fourth study was selected titled “The Process of Reporting and Receiving Support Following Exposure to Intimate Partner Violence during Childhood”

The fourth search was done on UTS library, with the keywords “trauma memories AND mental health”. This gave 81,214 results. The first study was selected from the results, which was a primary study done on Afghan youth.

The fifth search was done on Google Scholar, with the keywords “domestic violence behaviour problems” which showed 1,010,000 results. The first article was discarded for being too old (1993) and the second article by Moylan et al. (2010) was selected.

Critical analysis of the journals was based on key aspects of the study such as: the sample size and population, use of control groups, accuracy tools for measurement of data, chances of bias, the generalizability of the study, limitations of the study, and relevance of the finding to the research question. . For each of the key journal, the details like the title of the journal, authors, year of publication, country of origin, selected population and sample size, methodology and key findings are outlined, as well as their strengths, weaknesses  and relevance to the chosen topic. This strategy allowed a systematic review towards the effects of DV and IPV on children’s mental health, and allowed the presentation of the results thematically, based on the information obtained from the key journals, with supportive evidences from other studies (both primary and secondary studies).

Policy and Practice Background

Important ethical considerations for the study was to ensure that the information and thoughts expressed in this paper are original and free from plagiarism, and any source of information is properly referenced and cited. Secondly, all the data collected from the primary studies are expressed without any manipulation, to ensure authenticity and accuracy. Finally, it was also ensured that the anonymity of all respondents and participants in the selected studies are maintained in this paper, and no personal information is shared.

This study used an approach of the systematic literature review of primary research literature. The accuracy of the interpretation from this study is largely dependent on the accuracy of the data and analysis in those key research papers that were reviewed. Any biases incorporated in the key researches will also tend to be reflected in the views of this paper, and hence limit the accuracy of the results. However, such aspects are being limited by connecting findings in key research to other studies, to provide a wider context, and to ascertain or challenge the accuracy of the results.

Outlines of key papers

Title: Language disorders in victims of domestic violence in children’s homes

Authors: Martha Cobos-Cali, Valentina Ladera, María Victoria Perea and Ricardo García

Date: 2017

Country: Ecuador

Population: Children between 5 to 12 years of age, from first to seventh grades were selected for the study.

Sample Size: 104 participants were selected (48 male and 56 females)

Methodology: Primary research using “The Child Neuropsychological Assessment” by Matute et al. (2007) which involves oral, metalingustic, written and comprehension skills.

Findings: Their study showed that children who are victims of domestic violence showed a lower score or performance in a) measuring repetitive words and picture recognition b) reading accuracy, comprehension and speed c) writing accuracy, narrative composition and speed. This highlights an adverse effects on the cognitive and learning ability of children.

Title: Impacts of Family and Community Violence Exposure on Child Coping and Mental Health

Author: Esror Tamim Mohammad, Ester R. Shapiro, Laurel D. Wainwright and Alice S. Carter.

Date: 2014

Country: United States

Population: Children and their mothers from Latino, European-American and African-American communities from single parent families, who were either homeless or living in emergency shelters and are from low income groups.

Sample: From the initial sample of 436, of which 91 mothers and their children were selected for the study

Methodology: Secondary analysis of primary research data provided by Murray Centre for the Study of Lives, collected by Worcester Family Research Project between 1992 and 1995.

Methodology

Findings: Their results shows that family abuse is related to Post Traumatic Stress Disorder (PTSD)

Title: The Process of Reporting and Receiving Support Following Exposure to Intimate Partner Violence during Childhood

Author: Kathryn H. Howell, Åsa K. Cater,  Laura E. Miller-Graff, Sandra A. Graham-Bermann,

Date 2014

Country: Sweden

Population: The participants included young adults between the ages 20-24.

Sample: Of the initial sample of 2500 adults from Retrospective Study of Young People’s Experience, 703 individuals who were exposed to domestic violence in childhood were selected

Methodology: Qualitative Research Method. The data was collected through telephone survey of previous primary research participants on similar research topic.

Findings: The study showed that 43.4% of the individuals who were exposed to domestic violence, kept the incident concealed. Additionally, sharing of the event outside the family was mostly restricted to friends (53.2%), and only 5.2% of the reported cases were reported to authorities, police or social service.

Title: Trauma memories, mental health, and resilience: a prospective study of Afghan youth

Author: Catherine Panter-Brick, Marie-Pascale Grimon, Michael Kalin and Mark Eggerman

Date: 2014

Country: Afghanistan and Pakistan

Population: Interviews were conducted with children of the age group 11 to 16 years and their caregivers, in two waves, set apart by a year.

Sample: 331 individuals comprising of Afghan children and their caregivers.

Methodology: Qualitative research method-interviewing. The study analysed levels of reported distress in the participants using the “Child Revised Impact of Events Scale” (CRIES).

Findings: Youth who were exposed to four or more traumatic experience showed higher risks of rising distress and sustained distress.

Title: The Effects of Child Abuse and Exposure to Domestic Violence on Adolescent Internalizing and Externalizing Behaviour Problems

Authors: Carrie A. Moylan, Todd I. Herrenkohl, Cindy Sousa, Emiko A. Tajima, Roy C. Herrenkohl, and M. Jean Russo.

Date: January, 2010.

Country: United States

Population: Participants were selected from different settings in Pennsylvania: child welfare abuse and protective service programs, Head Start classrooms, day care centres and middle income private nursery schools, selecting children from preschool, school age and adolescent age groups.

Sample Size: 457 (248 males and 209 females) from initial sample, from which 416 samples were selected.

Methodology: Qualitative longitudinal research methodology with data been collected from Lehigh Longitudinal Study since 1976 to examine the developmental consequences of child maltreatment and domestic abuse using primary data.

Findings: Their results show a higher risk for children exposed to domestic violence, child abuse or both (dual exposure). Moreover, dual exposure also increased risks for the tested outcomes, in comparison to children never exposed to such stressors.

Steps taken to Identify Key Research

Both the assessment method and the use of control groups in the study was key strengths that added to the quality of the study and contributed to the validity of the results. Additionally the inclusion and exclusion criteria were clearly outlined that helped to understand the contexts clearer and reduced biases. However, the sample size of the population was small, which limited the generalizability of the study. Additionally, the study did not incorporate any double-blind trial system to prevent the possibility of any conscious or unconscious bias (Schulz et al. 1995).

The results of the study are highly relevant, since it shows the prevalence of language disorders in children who are victims of domestic violence, compared to the control group. This highlights the adverse effects on neuropsychology that lowers their written, oral, comprehensive, expressive and metalinguistic skills, thereby causing language disorders in them.

The study used different assessment scales to measure intrafamily conflict and violence such as Conflict Tactics Scale (CTS), Life Events Questionnaire (LEQ), the Strains and Worries Scale (STS), the Revised Children’s Manifest Anxiety Scale (RCMAS), Child Behaviour Checklist (CBCL), Post Traumatic Stress Disorder subscale (PTSD), and emotional regulation coping. Each of these tools is efficient means of measurement, which can be independently verified and audited (Clark et al. 2016; Schepis et al. 2015; Mohammad et al. 2015; Gerard and Reynolds 2014; Sterling et al. 2015; Lowe 2015; Masi et al. 2015; Foa et al. 2016; Hyland et al. 2017). However a major flaw in the research is the use of financial incentives to encourage participation, which can potentially lead to bias.

The relevance of the study can be highlighted by two aspects. The first aspect is drawn from the association of domestic violence with poverty and unemployment. Slabbert (2017) and Imbery (2014) pointed out the relation of domestic violence with poverty, while Anderberg et al. (2016) highlighted the relationship with unemployment status, which shows the significance of the selected population in the study. The second aspect is drawn from the result of the research that shows that risks of PTSD were higher due to exposure to domestic violence, while IPV was associated with aggression, and that emotional regulation coping mechanisms can moderate the effects of these stressors. This supports the studies by Kilpatrick and Williams (1997) who suggested the relationship between PTSD and domestic violence.

The strength of this study lies in the use of different assessment tools for analysing exposure to different types of aggression at home such as Child Exposure to Domestic Violence (CEDV) scale. Depressive and anxiety symptoms measured by Hospital Depression and Anxiety Scale (HADS) and Post Traumatic Stress measured using the 22 item Revised Impact of Event Scale IES-R (Howell et al. 2014; Edleson et al. 2008; Shin and Edleson 2008; Bjelland et al. 2002; Zigmond and Snaith 1983; Thomas et al. 2005; Eun et al. 2005). Furthermore the study also involved a significant sample size, all of which further adds to the strength and quality. However, major weakness lies in the absence of control group in the study, and the use of financial incentives. The inclusion and exclusion criteria are also not clearly outlined, and therefore making it difficult to understand the basis of selecting the sample size.

Terminologies Used

The study showed that children exposed chronically to IPV are either are not able or not willing to share their experiences (reduced reporting of the incident), which increases their sense of isolation, embarrassment, and perpetuates the secrecy of IPV. This in turn increases the risk factors of domestic violence which renders effective interventions more challenging. Figure 7 shows that informal disclosure to friends and peers is highest while disclosure to professionals such as social worker or teacher is the least. Figure 8 shows that the biggest reason for not disclosing incidents is due to a mindset that “nobody can do anything”. Figure 9 show that school staff, healthcare workers and social services are less likely to be contacted to report domestic violence, and most contacts are made to police and lest through anonymous hotlines.

Mental health screening tools such as Child Revised Impact of Events Scale (CRIES) was used to study the effect of memories of traumatic events on the mental health of the children. The strength of the study lies in the selection of the population, which has a known history of exposure to violence, attributed to the constant state of turmoil in the country (in.reuters.com 2017; Panter-Brick et al. 2009; Misra 2004; Catani et al. 2008; O’Loughlin et al. 2010; Misdaq 2006; Chesler 2009; Scholte et al. 2004), and the use of verifiable tools for measurement. However, the study only focussed broadly on trauma or traumatic experience.

The relevance of the study is highlighted by the results that show higher risks of distress symptoms experienced by the children due to multiple exposures to violence and trauma. This shows how repetitive exposure can complicate the mental health risks of the children.

The study measured exposure to violence (using official records, reports from mothers, and retrospective reports from adolescents), adolescent psychosocial functioning and behaviour (using the Achenbach Youth Self Report (YSR)), depressive symptoms (using Black Depression Inventory (BDI)) and delinquency (counting the number of delinquent acts). The quality and reliability of this study are enhanced by the use of several mental assessment tools. Also, comparison of the results with a control group further helps to reduce bias. However, the exclusion and inclusion criteria for the selection of the sample is not very clear.

The study highlights that the effects of dual exposure can increase the risks for externalising (like aggression) and internalizing (like depression) behaviours which shows how the adverse effects of domestic violence can be compounded when presented with other forms of violence such as war.

Review of the selected journals revealed the following key themes in connection with the effect of DV/ IPV on the mental health of children

• Relation to language disorders
• Relation to PTSD and anxiety disorder
• Secrecy about IPV that reduces or prevents help seeking behaviour
• The adverse effect of dual exposure causing internalising and externalising behaviour
• Relation to delinquent and aberrant behaviour

Effect of chronic exposure to domestic violence or IPV on neurocognitive development has been supported by several pieces of evidences. The study by Cobos-Cali et al. (2017) highlighted how it could lead to language disorders. Kanchiputu (2017) also highlighted the correlation between domestic violence on children’s education in their studies in Malawi. The studies showed the risk of psychological harm to the children, which ultimately affects their cognitive and academic performance, as they tend to lose interest in education. Cobos-Cali et al. (2017) also highlights the association between domestic violence and poverty. This consequence is of serious concern, since poor educational status can impede employability, and thereby propagate the cycle of cause-effect relationship between poverty/unemployment and domestic violence (Anderberg et al. 2016). Long term internalizing effects like PTSD and distress or depressive syndromes have been studied by Mohammad et al. (2014) in the US, Panter-Brick et al. (2014) in Afghanistan, and Moylan et al. (2010) in the US. Domestic Violence is also linked with  both externalizing effects and  externalising behaviours such as aggression, violence and delinquency in children after long-term exposure (Moylan et al. 2010; Mohammad et al. 2014).  De Jong (2016) terms the repeated exposure to domestic violence as ‘toxic stress’, stressing on the toxic (or adverse) effects of these stressors on social/behavioural outcomes, brain and neuroendocrine system, and even at the molecular and genetic levels. Cook et al. (2017) suggested that these stressors can cause lifelong problems that increase risks of addiction, additional exposure to trauma, chronic illness, legal, vocational and family problems) and these problems can well continue beyond childhood to adulthood. Furthermore, exposure to domestic violence can be linked to higher risks of sleep disorders among children (Spilsbury et al. 2016).

On social and Behavioural aspect, ‘toxic stress’ can reduce empathy and emotional quotient, impair cognitive development, and impair organizational skills. Exposures can also lead to ‘hair trigger’ response, hypervigilance, and poor control of impulse, difficulty in the regulation of their arousal, distrust, detachment, withdrawal, insecurity, and aggression (Kitzmann et al. 2003; Levendosky et al. 2003; Mullender et al. 2002; Hester 2007; Cook et al. 2017; Beckerman and Wozniak 2018; Gordon 2016). This shows the increased propensity of aberrant and delinquent behaviour, and even risks of homicide (Iratzoqui and McCutcheon 2018). Iratzoqui and McCutcheon (2018) also suggested that domestic violence might be an indicator of an overall tendency towards violent behaviour, and that history of domestic violence has been found to be more frequent in homicide cases. This further implies the risk to the wellbeing of the children living in households with chronic domestic violence. The effect of stress on the brain and neuroendocrine system is mediated by affecting the neuronal development during childhood in response to experience. It has been suggested that exposure to trauma can lead to smaller brain size, compared to children not exposed to ‘toxic stress’, furthermore, brain regions like anterior cingulate, corpus callosum, prefrontal cortex can show reduced activity thereby affecting their cognitive and emotional qualities, while hyperactivity of dorsolateral cortex and amygdale in response to ‘toxic stress’ can increase fear and aggression (Jong et al. 2016; Shonkoff et al. 2012; Garner et al. 2012; Johnson et al. 2013; Perry and Pollard 1998; Sapolsky 1996; Roozendaal et al. 2009; Rauch et al. 2000). Even at the genetic and molecular level, these exposures can affect gene expression by modulating the transcription and translation of the genes by the various transcription factors. This causes changes in the hormonal balance, increasing the action of stress hormones in the body, thereby causing further structural changes in the brain (especially due to chronic and prolonged exposure) (Jong et al. 2016).

The problem gets compounded by the propensity of inadequate or reduced help seeking behaviour by these children (Howell et al. 2014). The willingness to disclose family matters to outsiders, like a professional, compared to friends/peers and siblings as indicated by figure 7 above. While this attitude is propagated mainly through the belief that nobody can help them, apart from other factors like the children’s inability to identify domestic violence as being ‘wrong’, attempt to maintain secrecy from friends and fear, while few children would also not repost out of the fear of the perpetrator, or the fear that their account will not be taken seriously. Furthermore, the choice of formal reporting was highest for police (>40%) but significantly less for Social Services and Healthcare Workers (Howell et al. 2014). Thus, the risks of under reporting of the events are greatly increased, as well as leading to underutilization of social and healthcare services (Moylan et al. 2010). These risks also become more significant if the children are exposed to multiple stressors like both domestic violence and child abuse or multiple incidents of violence or trauma that can lead to behavioural problems or stress syndromes (Moylan et al. 2010; Panter-Brick 2014). These factors further implicate the chances of domestic violence and to be propagated to the next generation. Such a view can be supported by the fact that poor impulse control (that can cause gambling, violence or addiction), under reporting of incidents, and lack of education can cause domestic violence, as suggested by Susmitha (2016).

According to UNICEF statistics, about 240,000 to 963,000 children in the UK and 8000 to 42,000 in Ireland are exposed to domestic violence (unicef.org 2018). Similarly studies by Strickland and Allen (2017) show an increased amount of domestic violence reposted by police in England and Wales (over 900,000 incidents between 2014-15). These acts of domestic violence form part of Adverse Childhood Experience (ACE) which exerts an adverse effect on the physical as well as mental wellbeing of the children. The ecological model of violence in figure 5 shows how different contributory factors arise from different levels (personal, relationship, community and society) (who.int 2018). Therefore effective prevention of violent act should be multifaceted, directed towards each of these sources. However most importantly, interpersonal violence and domestic violence can be affected by both the biological history of ‘self’ and the relationship between individuals, and these aspects can be further stressed by the stressors arising from community and society in general (Howell et al. 2014).

The study on dual exposure (domestic violence and child abuse or other types of violence against children) in Moylan et al. (2010) further necessitates the requirement to investigate the exposure to each of the components of the dual exposure on children, to fully understand the effects. The moderating effects of Emotional Regulation Coping have been suggested by Shapiro et al. (2014), which also need further research to implement more efficient and effective interventions. Research on disclosure patterns during childhood have been proposed by Howell et al. (2014) to fully comprehend this process of decision making by children and the attitudes and behaviours related to it. This knowledge can be useful to ensure and support adequate help seeking and reporting behaviour that can assist in timely intervention and mitigation of risks. The importance of such strategies can be emphasized by the findings from British Crime Survey, that shows that individuals under 25 years are age the most prone to suffer IPV or domestic violence, as well as being perpetrators of such actions, as young men were found to be more prone to commit crimes compared to older men (Walby and Allen 2004).

The importance of making policy changes to identify through early intervention, of children who are at the risk of developing language problems due to the exposure to domestic violence has been proposed by Cobos-Cali et al. (2017). Wolf (2015) suggested that the unavailability of emergency services, and lack of proper funding as significant barriers in the providence of care in rural areas. The need for increased public spending has been highlighted by Ishkanian (2014), suggesting that it can lower the wider costs of domestic violence.

On the practice level, use of complex trauma treatment model has been suggested by Cook et al. (2017). The intervention can include six core components: self-reflection, safety, experience integration, self-regulation, relational engagement and enhancement of positive affect. Domestic Violence enquiry using self-report checklist for screening mothers experiencing domestic violence (MOVE) can also be an effective strategy for identifying potential cases and planning domestic violence interventions (Taft et al. 2015). An important change in the aspect of both research and practice in the study of domestic violence was proposed by Katz (2015), suggesting that children should not be considered as merely passive observers of violence, and instead their role in the parent child relation should be further studied, and used in practice. Importance of reflective analysis of traumatic events by children as well as their mothers suggested by Swanston et al. (2014) shows that such a practice can improve recognition of such events by children, as not being normal, and allows the mothers to comprehend the adverse long-term effects of these events on the wellbeing of themselves and that of their children. Wolfe and Korsch (1994) opined that a better exploration of the problem of domestic violence and improving the sensitivity of behavioural symptoms and clinical manifestations exhibited by children exposed to domestic violence is important for healthcare professionals, as well as the need to have an increased knowledge of the resources available to treat them or prevent further exposure. Yawn et al. (1992) proposed that a routine screening of all women patients in emergency service, primary care, surgical care, paediatric care, perinatal care or mental health setup for domestic violence, since some women might not be able to recognize themselves as victims of domestic violence. Intervention strategies should focus on the safety of patient, provide the victim with information and resources, and identify barriers  such as patient barriers (fear, shame, low self-esteem, protectiveness towards perpetrator, lack of awareness, and false beliefs) and physician batters (lack of awareness, misplaced sense of intrusion, lack of knowledge about the right course of action, and trusting the victim’s story) (Herman 2015; Iratzoqui and McCutcheon 2018; Cook et al. 2017; Van der Kolk 2017; Thabet et al. 2015).

Conclusion

Several psychological impacts have been identified by studies, caused by exposure to domestic violence, as well as its effects on neurobiology and endocrine system of children. Learning and language difficulties and cognitive problems can be caused due to these biological changes, which may further affect the children’s behaviour (Howell et al. 2014). The risks become even greater if the children are exposed to repeated events of domestic violence as a form of ‘chronic stress’ which can have ‘toxic effects’ on the children (De Jung 2015; Shonkoff et al. 2012; Garner et al. 2012). The unwillingness of victims to ‘report’the incidents further increases the perpetuation of the violent behaviour. Several laws and policies exist in the UK to protect victims of domestic violence, however, more effective early identification and follow-ups or investigation of probable cases can be effective to mitigate the adverse effects, and protect the children. Mechanisms such as Emotionally Regulated Coping are shown to protect the mental health of children from the adverse effects of trauma exposure. Such coping mechanisms, can help children to adjust to adverse life experiences, as studied by Panter-Brick et al. (2014). This study shows how rmotional regulation coping can be useful tool in helping children who experienced domestic violence to recover.

The study involves secondary analysis of qualitative and quantitative data from primary analyses. Hence the accuracy of the information extracted from the studies depends on the accuracy of the selected studies.

Further studies should be conducted on how Emotional Regulation Coping mediates beneficial effects on the mental health, and how such element can be incorporated into designing more efficient interventions for children exposed to domestic violence. Assessment of the metalinguistic and cognitive behaviour of children should be considered in the onset of any intervention as cognitive or behavioural problems can be an early indication of domestic abuse as studied by Cobos-Cali et al (2017). Furthermore, it is important to identify any signs of aggression, externalizing behaviour, PTSD among the victims, as proposed by Mohammad et al. (2014). Emotionally Regulated Coping strategies can be useful method to help these children as studies suggested. Additionally, focus should be on high risk groups such as families living in poverty or with unemployment as Anderberg et al (2016) shows a higher prevalence of domestic violence among these groups.  Also, considering the studies by Howell et al. (2014), it is important to encourage children to report cases of domestic violence to the concerned authorities or other adult family members. This can improve reporting and identification of the risky cases and enable better and quicker provision of help. Risky behaviours associated with exposure to domestic violence  studied by Moylan et al. (2010) can be used to identify these risk factors inn children exposed to such incidents.

Enabling a timely and adequate intervention strategy can help to reduce the burden on mental health services as well as the risk of aberrant or delinquent behaviour in children.

References:

Akhter, R. and Wilson, J.K., 2016. Using an ecological framework to understand Men’s reasons for spousal abuse: an investigation of the Bangladesh demographic and health survey 2007. Journal of family violence, 31(1), pp.27-38.

Anderberg, D., Rainer, H., Wadsworth, J. and Wilson, T., 2016. Unemployment and domestic violence: Theory and evidence. The Economic Journal, 126(597), pp.1947-1979.

Apps.who.int., 2018. Cite a Website – Cite This For Me. [online] Apps.who.int. Available at: https://apps.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf [Accessed 14 Feb. 2018].

Bair-Merritt, M.H., Ghazarian, S.R., Burrell, L., Crowne, S.S., McFarlane, E. and Duggan, A.K., 2015. Understanding how intimate partner violence Impacts school age children’s internalizing and externalizing problem behaviors: a secondary analysis of Hawaii Healthy Start Program evaluation data. Journal of child & adolescent trauma, 8(4), pp.245-251.

Beckerman, N.L. and Wozniak, D.F., 2018. Domestic violence counselors and secondary traumatic stress (STS): a brief qualitative report and strategies for support. Social Work in Mental Health, (just-accepted).

Bjelland, I., Dahl, A.A., Haug, T.T. and Neckelmann, D., 2002. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of psychosomatic research, 52(2), pp.69-77.

Callaghan, J., Alexander, J. and Fellin, L., 2016. Safe and unsafe spaces? Using drawings and photos to explore children’s sense of safety in domestic violence.

Campbell, J.C. and Messing, J. eds., 2017. Assessing Dangerousness: Domestic Violence Offenders and Child Abusers. Springer Publishing Company.

Catani, C., Schauer, E. and Neuner, F., 2008. Beyond individual war trauma: domestic violence against children in Afghanistan and Sri Lanka. Journal of Marital and Family Therapy, 34(2), pp.165-176.

Cater, Å. and Øverlien, C., 2014. Children exposed to domestic violence: a discussion about research ethics and researchers’ responsibilities. Nordic Social Work Research, 4(1), pp.67-79.

Cdc.gov., 2018. About Adverse Childhood Experiences. [online] Cdc.gov. Available at: https://www.cdc.gov/violenceprevention/acestudy/about_ace.html [Accessed 14 Feb. 2018].

Cdc.gov., 2018. Definitions|Intimate Partner Violence|Violence Prevention|Injury Center|CDC. [online] Cdc.gov. Available at: https://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html [Accessed 14 Feb. 2018].

Chesler, P., 2009. Are honor killings simply domestic violence?. Middle east quarterly.

Christian, H.E., Klinker, C.D., Villanueva, K., Knuiman, M.W., Foster, S.A., Zubrick, S.R., Divitini, M., Wood, L. and Giles-Corti, B., 2015. The effect of the social and physical environment on children’s independent mobility to neighborhood destinations. Journal of Physical Activity and Health, 12(6 Suppl 1), pp.S84-S93.

Clark, C.J., Alonso, A., Everson-Rose, S.A., Spencer, R.A., Brady, S.S., Resnick, M.D., Borowsky, I.W., Connett, J.E., Krueger, R.F., Nguyen-Feng, V.N. and Feng, S.L., 2016. Intimate partner violence in late adolescence and young adulthood and subsequent cardiovascular risk in adulthood. Preventive medicine, 87, pp.132-137.

Cobos-Cali, M., Ladera, V., Perea, M.V. and García, R., 2017. Language disorders in victims of domestic violence in children’s homes. Child abuse & neglect.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J. and Mallah, K., 2017. Complex trauma in children and adolescents. Psychiatric annals, 35(5), pp.390-398.

Costa, B.M., Kaestle, C.E., Walker, A., Curtis, A., Day, A., Toumbourou, J.W. and Miller, P., 2015. Longitudinal predictors of domestic violence perpetration and victimization: A systematic review. Aggression and violent behavior, 24, pp.261-272.

Cross, D., Barnes, A., Papageorgiou, A., Hadwen, K., Hearn, L. and Lester, L., 2015. A social–ecological framework for understanding and reducing cyberbullying behaviours. Aggression and Violent Behavior, 23, pp.109-117.

De Jong, A.R., 2016. Domestic violence, children, and toxic stress. Widener L. Rev., 22, p.201

Dishion, T.J., 2014. A developmental model of aggression and violence: Microsocial and macrosocial dynamics within an ecological framework. In Handbook of developmental psychopathology (pp. 449-465). Springer, Boston, MA.

Domesticviolence.com.au., 2018. Impact Of Domestic Violence On Children And Young People. [online] Domesticviolence.com.au. Available at: https://www.domesticviolence.com.au/pages/impact-of-domestic-violence-children-and-young-people.php [Accessed 14 Feb. 2018].

domesticviolenceroundtable.org., 2018. Effects of Domestic Violence on Children. [online] Domesticviolenceroundtable.org. Available at: https://www.domesticviolenceroundtable.org/effect-on-children.html [Accessed 14 Feb. 2018].

Dong, M., Anda, R., Felliti, V., Dube, S., Williamson, D., Thompson, T., Loo, C. and Giles, W.,2004. The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. [online] Web.archive.org. Available at: https://web.archive.org/web/20131206234513/https://www.thecapcenter.org/admin/upload/ACEs%20Inter-Relatedness%20Article%202004.pdf [Accessed 14 Feb. 2018].

Eckenrode, J., Ganzel, B., Henderson Jr, C.R., Smith, E., Olds, D.L., Powers, J., Cole, R., Kitzman, H. and Sidora, K., 2000. Preventing child abuse and neglect with a program of nurse home visitation: The limiting effects of domestic violence. Jama, 284(11), pp.1385-1391.

Edleson, J.L., Shin, N. and Armendariz, K.K.J., 2008. Measuring children’s exposure to domestic violence: The development and testing of the Child Exposure to Domestic Violence (CEDV) Scale. Children and Youth Services Review, 30(5), pp.502-521.

Eif.org.uk., 2018. Domestic Violence and Abuse | Early Intervention Foundation. [online] Eif.org.uk. Available at: https://www.eif.org.uk/domestic-violence-and-abuse/ [Accessed 16 Feb. 2018].

Eun, H.J., Kwon, T.W., Lee, S.M., Kim, T.H., Choi, M.R. and Cho, S.J., 2005. A study on reliability and validity of the Korean version of impact of event scale-revised. Journal of Korean Neuropsychiatric Association, 44(3), pp.303-310.

Foa, E.B., McLean, C.P., Zang, Y., Zhong, J., Rauch, S., Porter, K., Knowles, K., Powers, M.B. and Kauffman, B.Y., 2016. Psychometric properties of the Posttraumatic Stress Disorder Symptom Scale Interview for DSM–5 (PSSI–5). Psychological assessment, 28(10), p.1159.

Foshee, V.A., Reyes, H.L.M., Chen, M.S., Ennett, S.T., Basile, K.C., DeGue, S., Vivolo-Kantor, A.M., Moracco, K.E. and Bowling, J.M., 2016. Shared risk factors for the perpetration of physical dating violence, bullying, and sexual harassment among adolescents exposed to domestic violence. Journal of youth and adolescence, 45(4), pp.672-686.

Garner, A.S., Shonkoff, J.P., Siegel, B.S., Dobbins, M.I., Earls, M.F., McGuinn, L., Pascoe, J., Wood, D.L., Committee on Psychosocial Aspects of Child and Family Health and Committee on Early Childhood, Adoption, and Dependent Care, 2012. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 129(1), pp.e224-e231.

Gerard, A.B. and Reynolds, C.R., 2014. Characteristics and applications of the Revised Children’s Manifest Anxiety Scale (RCMAS). The Use of Psychological Testing for Treatment Planning and Outcomes Assessment: Volume 2: Instruments for Children and Adolescents, 2, p.63.

Gordon, J.S., 2016. Helping survivors of domestic violence: The effectiveness of medical, mental health, and community services (Vol. 2). Routledge.

Gov.uk., 2018. Domestic violence and abuse – GOV.UK. [online] Available at: https://www.gov.uk/guidance/domestic-violence-and-abuse [Accessed 16 Feb. 2018].

Herman, J.L., 2015. Trauma and recovery: The aftermath of violence–from domestic abuse to political terror. Hachette UK.

Herman, J.L., 2015. Trauma and recovery: The aftermath of violence–from domestic abuse to political terror. Hachette UK.

Hester, M., 2007. Making an impact: Children and domestic violence: A reader. Jessica Kingsley Publishers.

Howell, K.H., Cater, Å.K., Miller-Graff, L.E. and Graham-Bermann, S.A., 2015. The process of reporting and receiving support following exposure to intimate partner violence during childhood. Journal of interpersonal violence, 30(16), pp.2886-2907.

Hyland, P., Shevlin, M., Brewin, C.R., Cloitre, M., Downes, A.J., Jumbe, S., Karatzias, T., Bisson, J.I. and Roberts, N.P., 2017. Validation of post?traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire. Acta Psychiatrica Scandinavica, 136(3), pp.313-322.

Imbery, L., 2014. The Intersection of Poverty and Domestic Violence – Coalition on Human Needs. [online] Coalition on Human Needs. Available at: https://www.chn.org/2014/10/16/intersection-poverty-domestic-violence/#.WoWrma6WbIU [Accessed 15 Feb. 2018].

in.reuters.com., 2017. Afghanistan political turmoil deepens as regional leader ousted. [online] Reuters. Available at: https://in.reuters.com/article/afghanistan-politics/afghanistan-political-turmoil-deepens-as-regional-leader-ousted-idINKBN1EE173 [Accessed 15 Feb. 2018].

Iratzoqui, A. and McCutcheon, J., 2018. The Influence of Domestic Violence in Homicide Cases. Homicide Studies, p.1088767917751673.

Ishkanian, A., 2014. Neoliberalism and violence: The Big Society and the changing politics of domestic violence in England. Critical Social Policy, 34(3), pp.333-353.

Johnson, S.B., Riley, A.W., Granger, D.A. and Riis, J., 2013. The science of early life toxic stress for pediatric practice and advocacy. Pediatrics, 131(2), pp.319-327.

Johnston, K., Prentice, K., Whitehead, H., Taylor, L., Watts, R. and Tranah, T., 2016. Assessing effective participation in vulnerable juvenile defendants. The Journal of Forensic Psychiatry & Psychology, 27(6), pp.802-814.

Kanchiputu, P., 2017. Effects of Domestic Violence on Children’s Education: The Case Study of Mpemba, in Blantyre District [Malawi]. Journal of Psychological Abnormalities, 05(02).

Katz, E., 2015. Domestic violence, children’s agency and mother–child relationships: Towards a more advanced model. Children & Society, 29(1), pp.69-79.

Kelly, L. and Westmarland, N., 2016. Naming and defining ‘domestic violence’: Lessons from research with violent men. Feminist review, 112(1), pp.113-127.

Kilpatrick, K.L. and Williams, L.M., 1997. Post-traumatic stress disorder in child witnesses to domestic violence. American journal of orthopsychiatry, 67(4), p.639.

Kitzmann, K.M., Gaylord, N.K., Holt, A.R. and Kenny, E.D., 2003. Child witnesses to domestic violence: a meta-analytic review. Journal of consulting and clinical psychology, 71(2), p.339.

Labrum, T. and Solomon, P.L., 2015. Physical elder abuse perpetrated by relatives with serious mental illness: A preliminary conceptual social–ecological model. Aggression and violent behavior, 25, pp.293-303.

Legislation.gov.uk (2018). Protection from Harassment Act 1997. [online] Legislation.gov.uk. Available at: https://www.legislation.gov.uk/ukpga/1997/40/contents [Accessed 19 Mar. 2018].

Legislation.gov.uk (2018). Serious Crime Act 2015. [online] Legislation.gov.uk. Available at: https://www.legislation.gov.uk/ukpga/2015/9/section/76/enacted [Accessed 19 Mar. 2018].

Levendosky, A.A., Huth-Bocks, A.C., Shapiro, D.L. and Semel, M.A., 2003. The impact of domestic violence on the maternal-child relationship and preschool-age children’s functioning. Journal of family psychology, 17(3), p.275.

Lowe, P.A., 2015. The revised children’s manifest anxiety scale–second edition short form: examination of the psychometric properties of a brief measure of general anxiety in a sample of children and adolescents. Journal of Psychoeducational Assessment, 33(8), pp.719-730.

Masi, G., Muratori, P., Manfredi, A., Pisano, S. and Milone, A., 2015. Child behaviour checklist emotional dysregulation profiles in youth with disruptive behaviour disorders: clinical correlates and treatment implications. Psychiatry research, 225(1), pp.191-196.

Matthews, H. and Limb, M., 1998. The right to say: the development of youth councils/forums within the UK. Area, 30(1), pp.66-78.

Matute, E., Rosselli, M., Ardila, A. and Ostrosky-Solís, F., 2007. Evaluación neuropsicológica infantil. México: Manual Moderno.

Melchiorre, M.G., Di Rosa, M., Lamura, G., Torres-Gonzales, F., Lindert, J., Stankunas, M., Ioannidi-Kapolu, E., Barris, H., Macassa, G. and Soares, J.J., 2016. Abuse of Older Men in Seven European Countries: A Multilevel Approach in the Framework of an Ecological Mode.

Merrin, G.J., Espelage, D.L. and Hong, J.S., 2018. Applying the social-ecological framework to understand the associations of bullying perpetration among high school students: A multilevel analysis. Psychology of Violence, 8(1), p.43.

Milaniak, I. and Widom, C.S., 2015. Does child abuse and neglect increase risk for perpetration of violence inside and outside the home?. Psychology of violence, 5(3), p.246.

Misdaq, N., 2006. Afghanistan: Political frailty and external interference. Routledge.

Misra, A., 2004. Afghanistan: The Labyrinth of Violence. Polity Press.

Mohammad, E.T., Shapiro, E.R., Wainwright, L.D. and Carter, A.S., 2015. Impacts of family and community violence exposure on child coping and mental health. Journal of abnormal child psychology, 43(2), pp.203-215.

Moylan, C.A., Herrenkohl, T.I., Sousa, C., Tajima, E.A., Herrenkohl, R.C. and Russo, M.J., 2010. The effects of child abuse and exposure to domestic violence on adolescent internalizing and externalizing behavior problems. Journal of family Violence, 25(1), pp.53-63.

Mullender, A., Hague, G., Imam, U.F., Kelly, L., Malos, E. and Regan, L., 2002. Children’s perspectives on domestic violence. Sage.

Murray, C. and Hallett, C., 2000. Young people’s participation in decisions affecting their welfare. Childhood, 7(1), pp.11-25.

Nhs.uk., 2018. Domestic violence and abuse – NHS Choices. [online] Nhs.uk. Available at: https://www.nhs.uk/livewell/abuse/pages/domestic-violence-help.aspx [Accessed 14 Feb. 2018].

nspcc.org.uk (2018). Domestic abuse. [online] NSPCC. Available at: https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/domestic-abuse [Accessed 19 Mar. 2018].

O’Loughlin, J., Witmer, F.D. and Linke, A.M., 2010. The Afghanistan-Pakistan wars, 2008-2009: micro-geographies, conflict diffusion, and clusters of violence. Eurasian Geography and Economics, 51(4), pp.437-471.

pakobserver.net., 2018. Afghanistan in turmoil – PakObserver. [online] Pakistan Observer. Available at: https://pakobserver.net/afghanistan-in-turmoil/ [Accessed 15 Feb. 2018].

Panter-Brick, C., Eggerman, M., Gonzalez, V. and Safdar, S., 2009. Violence, suffering, and mental health in Afghanistan: a school-based survey. The Lancet, 374(9692), pp.807-816.

Panter?Brick, C., Grimon, M.P., Kalin, M. and Eggerman, M., 2015. Trauma memories, mental health, and resilience: A prospective study of Afghan youth. Journal of Child Psychology and Psychiatry, 56(7), pp.814-825.

Perry, B.D. and Pollard, R., 1998. Homeostasis, stress, trauma, and adaptation: A neurodevelopmental view of childhood trauma. Child and adolescent psychiatric clinics of North America.

Rauch, S.L., Whalen, P.J., Shin, L.M., McInerney, S.C., Macklin, M.L., Lasko, N.B., Orr, S.P. and Pitman, R.K., 2000. Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: a functional MRI study. Biological psychiatry, 47(9), pp.769-776.

Roozendaal, B., McEwen, B.S. and Chattarji, S., 2009. Stress, memory and the amygdala. Nature Reviews Neuroscience, 10(6), p.423.

Sapolsky, R.M., 1996. Why stress is bad for your brain. Science, 273(5276), pp.749-750.

Schepis, T.S., Cavallo, D.A., Kong, G., Liss, T., Liss, A. and Krishnan-Sarin, S., 2015. Predicting initiation of smoking cessation treatment and outcome among adolescents using stressful life events and coping style. Substance abuse, 36(4), pp.478-485.

Scholte, W.F., Olff, M., Ventevogel, P., de Vries, G.J., Jansveld, E., Cardozo, B.L. and Crawford, C.A.G., 2004. Mental health symptoms following war and repression in eastern Afghanistan. Jama, 292(5), pp.585-593.

Schulz, K.F., Chalmers, I., Hayes, R.J. and Altman, D.G., 1995. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. Jama, 273(5), pp.408-412.

Shin, N. and Edleson, J.L., 2008. A new scale for assessing child exposure to domestic violence. Exposure to Violence: A Significant Issue for Children and Families.

Shonkoff, J.P., Garner, A.S., Siegel, B.S., Dobbins, M.I., Earls, M.F., McGuinn, L., Pascoe, J., Wood, D.L., Committee on Psychosocial Aspects of Child and Family Health and Committee on Early Childhood, Adoption, and Dependent Care, 2012. The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), pp.e232-e246.

Sitnick, S.L., Shaw, D.S., Weaver, C.M., Shelleby, E.C., Choe, D.E., Reuben, J.D., Gilliam, M., Winslow, E.B. and Taraban, L., 2017. Early Childhood Predictors of Severe Youth Violence in Low?Income Male Adolescents. Child development, 88(1), pp.27-40.

Slabbert., 2017. Domestic Violence and Poverty Some Women’s Experiences. [online] Available at: https://journals.sagepub.com/doi/abs/10.1177/1049731516662321 [Accessed 15 Feb. 2018].

Spilsbury, J.C., Frame, J., Magtanong, R. and Rork, K., 2016. Sleep environments of children in an urban US setting exposed to interpersonal violence. Behavioral sleep medicine, 14(6), pp.585-601.

Sterling, L., Renno, P., Storch, E.A., Ehrenreich-May, J., Lewin, A.B., Arnold, E., Lin, E. and Wood, J., 2015. Validity of the Revised Children’s Anxiety and Depression Scale for youth with autism spectrum disorders. Autism, 19(1), pp.113-117.

 Strickland, P. and Allen, G. (2017). Domestic Violence in England and Wales – Parliament UK. [online] Researchbriefings.files.parliament.uk. Available at: https://researchbriefings.files.parliament.uk/documents/SN06337/SN06337.pdf [Accessed 26 Mar. 2018].

Susmitha B., 2016. Domestic Violence: Causes, Impact and Remedial Measures. Social Change, 46(4), pp.602-610.

Swanston, J., Bowyer, L. and Vetere, A., 2014. Towards a richer understanding of school-age children’s experiences of domestic violence: The voices of children and their mothers. Clinical child psychology and psychiatry, 19(2), pp.184-201.

Taft, A.J., Hooker, L., Humphreys, C., Hegarty, K., Walter, R., Adams, C., Agius, P. and Small, R., 2015. Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): a cluster randomised trial. BMC medicine, 13(1), p.150.

Thabet, A.A., Tawahina, A.A., Tischler, V. and Vostanis, P., 2015. PTSD, depression, and anxiety among Palestinian women victims of domestic violence in the Gaza Strip. British Journal of Education, Society & Behavioural Science, 11(2).

Thomas, B.C., Devi, N., Gangadharan, P.S. and Krishnan, R., 2005. Reliability & validity of the Malayalam hospital anxiety & depression scale (HADS) in cancer patients. Indian Journal of Medical Research, 122(5), p.395.

Tsavoussis, A., Stawicki, S., Stoicea, N. and Papadimos, T.J., 2014. Child-witnessed domestic violence and its adverse effects on brain development: a call for societal self-examination and awareness. Frontiers in public health, 2, p.178.

Unicef.org., 2018. Behind Closed Doors The Impact of Domestic Violence on Children. [online] Unicef.org. Available at: https://www.unicef.org/media/files/BehindClosedDoors.pdf [Accessed 14 Feb. 2018].

unwomen.org , 2018. Facts and figures: Ending violence against women. [online] UN Women. Available at: https://www.unwomen.org/en/what-we-do/ending-violence-against-women/facts-and-figures [Accessed 14 Feb. 2018].

Van der Kolk, B.A., 2017. Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric annals, 35(5), pp.401-408.

Van der Kolk, B.A., 2017. Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric annals, 35(5), pp.401-408.

Völkl-Kernstock, S., Huemer, J., Jandl-Jager, E., Abensberg-Traun, M., Marecek, S., Pellegrini, E., Plattner, B. and Skala, K., 2016. Experiences of domestic and school violence among child and adolescent psychiatric outpatients. Child Psychiatry & Human Development, 47(5), pp.691-695.

Walby, S. and Allen, J., 2004. Domestic violence, sexual assault and stalking: Findings from the British Crime Survey. Home Office.

who.int., 2018. WHO multi-country study on women’s health and domestic violence against women. [online] World Health Organization. Available at: https://www.who.int/reproductivehealth/publications/violence/24159358X/en/ [Accessed 14 Feb. 2018].

Wolf, M. (2015). Barriers To Adequate Services For Rural Victims Of Domestic Violence. [online] Winona.edu. Available at: https://www.winona.edu/counseloreducation/media/rural%20victims.pdf [Accessed 17 Feb. 2018]..

Wolfe, D.A. and Korsch, B., 1994. Witnessing domestic violence during childhood and adolescence: implication for pediatric practice. Pediatrics, 94(4), pp.594-599

Yawn, B., Yawn, R. and Uden, D., 1992. American Medical Association diagnostic and treatment guidelines on domestic violence. Archives of Family Medicine, 1, p.39.

Zigmond, A.S. and Snaith, R.P., 1983. The hospital anxiety and depression scale. Acta psychiatrica scandinavica, 67(6), pp.361-370.